Recurrent synovial chondromatosis of the temporomandibular joint: report of two cases

Synovial chondromatosis: a case series and review of the literature

This case series reviews 2 patients worked up and treated for unilateral synovial chondromatosis of the temporomandibular joint (TMJ). The first was a 58-year-old female evaluated and treated for synovial chondromatosis of the left TMJ using an arthrotomy of the joint to remove the cartilaginous and osteocartilaginous nodules. The second is a 63-year-old male who was evaluated and treated for synovial chondromatosis of the right TMJ with the removal of extracapsular masses and an arthrotomy with intra-joint removal of nodules. Six-year radiographic follow-up demonstrated no recurrence of the pathology in his case. The cases are reviewed in this article, along with a current review of the literature.

A Case of Synovial Chondromatosis of Temporomandibular Joint with Numerous Loose Bodies

Here, we report a case of synovial chondromatosis of the temporomandibular joint (TMJ) with numerous loose bodies. A 56-year-old woman was examined in the oral surgery department for trismus and pain in the left TMJ when opening the mouth. Imaging indicated TMJ synovial chondromatosis, and the patient was referred to our department for further examination. Her facial features were symmetrical, and no occlusal abnormalities were found. The maximum mouth opening was 30 mm, and movement of the left mandibular condyle was restricted and accompanied by pain and joint sounds. Panoramic radiography showed deformation of the left mandibular condyle and radiopaque lesions surrounding it. Computed tomography showed numerous small granules around the left mandibular condyle, some of which were calcified. Magnetic resonance imaging showed anterior disc displacement without reduction in the left TMJ and hypointense lesions on T2-weighted images. Bone scintigraphy showed an accumulation in the area of the left TMJ. Based on the diagnosis of the left TMJ synovial chondromatosis, the lesions were removed, and plastic surgery on the mandibular condyle was performed under general anesthesia. We removed 386 white loose bodies. Histopathologically, the loose bodies were consistent with synovial chondromatosis lesions. The postoperative course was uneventful, with no recurrence or TMJ dysfunction approximately 5 years after the surgery, indicating that open surgery is the best course of intervention in such cases.

Restricted Mouth Opening in Head and Neck Cancer: Etiology, Prevention, and Treatment

Restricted mouth opening or trismus is often encountered in patients with head and neck cancer. The restriction may be the presenting sign of malignancy, a sequela of tumor site or growth, an adverse effect of oncologic treatment, or a first sign of tumoral recurrence. In general, any insult to the temporomandibular joint, masticatory muscles, or their neural innervation may cause limitation in mouth opening. The etiologies leading to trismus are as follows: myospasm secondary to tumor infiltration; reflectory myospasm; radiation-induced myositis and myofibrosis; temporomandibular joint involvement with tumor; unfavorable postsurgical scarring; muscle and joint atrophy secondary to immobilization; pain; jaw fracture and hardware failure; and infection. Preventive measures should be implemented before, during, and after treatment. These measures include identification of high-risk patients, utilization of dose-sculpting radiation techniques whenever possible, performing reconstruction at the same time of resective surgery whenever feasible, and initiating mobilization exercises as early as possible. When trismus develops, treatments are often challenging and disappointing. These include physical therapy, mouth opening appliances, drug therapy, and release surgery. All medical specialties dealing with head and neck cancer should be familiar with the diagnosis and prevention of trismus and make an effort to ensure patients are referred to the appropriate care when needed. Trismus should not be considered a trivial sequela of head and neck cancer.

Diagnosis of Synovial Chondromatosis of Temporomandibular Joint: Case Report and Literature Review

Synovial chondromatosis is a non-cancerous tumor characterized by the formation of multiple nodules of cartilage due to metaplastic development of the synovial membrane. Etiology can be a primary lesion, of which pathogenesis remains unknown, or low-grade trauma or internal disorders. This pathology can long remain undiagnosed and leads to therapeutic wandering, especially since clinical manifestations are non-specific. Symptoms may mimic temporomandibular disorders and dental orthopantomogram does not always show intra-articular calcified bodies. Cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) are tests of choice for the diagnosis of this pathology. This case report describes the clinical manifestations, diagnosis and management of a case of synovial chondromatosis involving the temporomandibular joint, in a 21-year-old woman who was initially treated for two years for a common temporo-mandibular disorder. The evidence gathered during the medical interview and clinical examination led us to suspect synovial chondromatosis of the temporomandibular joint. Prescription of a CBCT and MRI confirmed the diagnosis of her temporomandibular joint disorder and led to a successful arthroplasty.

Synovial Chondromatosis of the Temporomandibular Joint

Synovial chondromatosis is a rare condition characterized by the presence of loose cartilaginous bodies, due to the abnormal proliferation of synovial membrane. However, its manifestation in the temporomandibular joint is a rare finding, occurring predominantly in females. This case report describes the clinical features, diagnosis and management of a case of synovial chondromatosis.